Healthcare Provider Details

I. General information

NPI: 1740739366
Provider Name (Legal Business Name): NICHOLAS BASTON PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NICHOLAS BAGGETT

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 EASTON OVAL STE 115
COLUMBUS OH
43219-6036
US

IV. Provider business mailing address

2 EASTON OVAL STE 115
COLUMBUS OH
43219-6036
US

V. Phone/Fax

Practice location:
  • Phone: 216-468-5000
  • Fax:
Mailing address:
  • Phone: 216-468-5000
  • Fax: 801-704-9741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10687736-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN.CNP.019771
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.019771
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: